Measles, mumps, rubella, and varicella

There are several combination vaccines available in the United States. One of the most popular pediatric combinations is Pediarix a combination of diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, and hepatitis B vaccines. ComVax is a combination of Haemophilus influenzae type b and hepatitis B vaccines. The most recent combination is ProQuad which contains measles, mumps, rubella, and varicella vaccines. The only combination available for adults is Twinrix which has hepatitis A and hepatitis B vaccines. 

Appendices 122-1 and 122-2 show the recommended schedules for routine immunization of children and adults. Many states require children to be fuUy immunized prior to entering elementary school however, optimal protection is achieved by immunizing at the recommended ages, which requires special attention to children younger than 2 years of age. Adults and adolescents also require vaccination and often are unaware of this need. Adults should receive routine tetanus-diphtheria boosters and be immune to measles, mumps, rubella, and varicella by either immunization or history of infection. Certain individuals with conditions or lifestyles that put them at high risk for vaccine-preventable diseases also should be immunized as described in the text that follows and outlined in the immunization schedules in the appendices. 

The combination measles, mumps, rubella and varicella (MMRV) vaccine was licenced for use in 2013. GACVS commented that there is a new risk of febrile seizures in the 12- to 23-month age group after this vaccine when compared to children receiving separate vaccinations [33 ]. 

Ruger G, Gabutti G, Rumke H, Rombo L, Bemaola E, EHez-Domingo J, et al. Safety of a 2-dose regimen of a combined measles, mumps, rubella and varicella live vaccine manufactured with recombinant human albumin. Pediatr Infect Dis J 2012 31(ll) 1166-72. 

Strongly Recommended Diseases posing special risks including hepatitis B, influenza, measles, mumps, rubella, and varicella. 

In the USA, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program as a federal no-fault compensation system for individuals who may have been injured by specific vaccines. This compensation program relies on a Vaccine Injury Table that lists the vaccines that are covered by the program, as well as injuries, disabilities, illnesses, and conditions (including death) for which compensation may be awarded. To better reflect current scientific knowledge about vaccine injuries, the Vaccine Injury Table was revised in 1995 and has been subsequently further modified. The latest modification, which became effective on December 1, 2004, is shown in Table 7. This revision took into account a review of the literature on specific adverse consequences of pertussis and rubella vaccines performed and published by the lOM (SED-12, 817) (SED-12, 825). In addition to the seven vaccines (diphtheria, pertussis, tetanus, measles, mumps, rubella, and poliomyelitis) included in the first Vaccine Injury Table, the 1997 revision includes hepatitis B, Hemophilus influenzae type b, and Varicella vaccines, as well as any future licensed vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) for routine administration to children (38). 

IGIM should be injected into a deltoid or gluteal muscle. It does not affect the immune response of inactivated vaccines, oral polio virus, or yellow fever vaccine. The administration of live vaccines [e.g., measles, mumps, rubella (MMR) vaccine] concomitantly with IGIM may decrease the immune response significantly thus, MMR and varicella vaccine should be delayed for at least 3 and 5 months, respectively, after IGIM has been administered. Additionally, IGIM should not be given within 2 weeks of the MMR administration or within 3 weeks of the varicella vaccine to maximize the efficacy of the immunization.1... 

Most health care workers are at risk for exposure to many diseases in the normal course of their work. Additionally, health care workers may transmit vaccine-preventable diseases to their patients. At the time of employment and on a regular basis, health care workers should be screened for immunity to measles, rubella, and varicella if found to be non-immune, the measles, mumps, and rubella, and varicella vaccines should be administered. The hepatitis B series should be given if not already completed. Tetanus should be updated and given every 10 years. Health care personnel in hospitals and ambulatory settings with direct patient contact should receive Tdap if not already received an interval as short as 2 years from the last tetanus-containing vaccine should be used. Priority for receiving Tdap should be given to personnel with direct contact with infants less than 12 months of age. 

The most notable example of live attenuated vaccines is the smallpox vaccine, first developed by Edward Jenner, although the origin of the vaccine (vaccinia virus) remains obscure. More recent examples of live attenuated vaccines include most of the viral vaccines currently in use, such as measles/mumps/rubella (MMR) and varicella zoster (VZV) vaccines, and some... 

Hepatitis A vaccine can be given concomitantly with Ig however, the antibody titer obtained is lower (bnt stiU protective) than when the vaccine is given alone. Ig can interfere with the response to measles, mumps, rubella (MMR), and varicella vaccines. Administration of MMR vaccine should be delayed for at least 3 months after administration of Ig (5 months for varicella vaccine). Conversely, Ig should not be administered within 2 weeks after the administration of MMR (3 weeks for varicella vaccine), nnless the benefits of Ig clearly ontweigh the benefits of vaccination. If Ig is administered within 2 weeks after administration of MMR (3 weeks for varicella vaccine), the person should be revaccinated—bnt no sooner than 3 months (5 months for varicella) after Ig. ... 

Drag admiuistratiou route Intramuscular and subcutaneous administration of two doses of measles-mumps-rubella-varicella (MMRV)... 

Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, Baxter R, Hambidge S, Nordin J, Naleway A, Belongia EA, Lieu T, Baggs J, Weintraub E Vaccine Safety Data-link. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics 2010 126(1) el-8. 

Knuf M, Zepp F, Meyer CU, Habermehl P, Maurer L, Burow HM, Behre U, Janssens M, Willems P, Bisanz H, Vetter V, Schmidt-Ott R. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles-mumps-rubella-varicella... 

Children in the United States are vaccinated against a growing list of diseases pertussis (whooping cough), diphtheria, tetanus, measles, mumps, rubella, varicella (chicken pox), polio, hepatitis B, and pneumococcal disease. Annual influenza vaccination, depending on the prevalent viral strain, is recommended for most age groups. The HlNl influenza pandemic of 2009 saw the rapid development of an effective vaccine however, a vaccine for HIV remains ellusive. 

Varicella vaccine should be administered after 12 months of age and a second dose at 4 years of age. Adolescents and adults without evidence of immunity to varicella zoster should receive two doses of varicella vaccine given 4 to 8 weeks apart. Varicella vaccine is available as a single-component vaccine or in combination with measles, mumps, and rubella vaccine. 

Following hematopoietic stem cell transplantation the patient will need virtually all routine vaccines to be administered again however, the patient will not be able to mount an adequate response for 6 to 12 months post-transplant. Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal, and inactivated poliovirus should be given at 12,14, and 24 months post-hematopoietic stem cell transplantation. Inactivated influenza vaccine should be given yearly, starting 6 months after transplant. Measles, mumps and rubella can be given 2 years after transplant and varicella vaccine is contraindicated.16... 

Currently available live vaccines include measles, mumps, polio, rubella, vaccinia (smallpox), varicella (chickenpox), and yellow fever. All of these are made from viruses. There are two live bacterial vaccines 1) Bacillus of Calmette and Guerin (BCG) vaccine for tuberculosis and 2) oral typhoid. 

Varicella. The varicella (chicken pox) vaccine was approved in April 1995 for immunization of children. A single dose at one year of age is recommended. In the future if may be combined with measles, mumps, and rubella. 

Usually the invading organisms are pyogenic (staphylococci, pneumococci, etc.), but others, such as pneumocystis carinii, are found in some 15% (B28). Gastrointestinal, skin, and eye infections, meningitis and septicemia, and infection of several systems also occur, each with an incidence of about 15%. Tuberculosis occurs in some 5%, a higher rate than expected in normals. Most virus infections such as vaccinia, measles, mumps, varicella, and rubella are dealt with normally. A notable exception is infective hepatitis, which can be rapidly fatal or... 

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